The Legislature finds and declares that the practice
of respiratory therapy in Alabama affects the public
health, safety, and welfare of the citizens of
Alabama. It, therefore, should be subject to
regulation and control, in the public interest to
protect the citizenry against the unauthorized,
unqualified, and improper administration of
respiratory therapy and from unprofessional or
unethical conduct by persons licensed to practice
respiratory therapy.

As used in this chapter, the following terms shall have the following
meanings:

(1) BOARD. The Alabama State Board of Respiratory Therapy

(2) DIRECT CLINICAL SUPERVISION. A situation where a licensed respiratory
therapist or physician is available for the purpose of communication,
consultation, and assistance.

(3) HEALTHCARE FACILITY. The definition shall be the same as in Section
22-21-260.

(4) MEDICALLY APPROVED PROTOCOL. A detailed plan for taking specific
diagnostic or treatment actions, or both, authorized by the treating
physician of the patient, all of which actions shall be:

(a) In a hospital or other inpatient health care facility, approved by the
supervising physician of the respiratory therapist or in an outpatient
treatment setting approved by the supervising physician of the respiratory
therapist.

(b) Except in cases of medical emergency, instituted following an evaluation
of the patient by a physician or otherwise directed by the supervising
physician of the respiratory therapist.

(c) Consistent with the definition of the scope of practice of respiratory
therapy, as established by this chapter.

(5) PHYSICIAN. A person who is a doctor of medicine or a doctor of
osteopathy licensed to practice in this state.

(6) RESPIRATORY THERAPIST. A person licensed by the board to administer
respiratory therapy and who has the knowledge and skills necessary to
administer respiratory therapy, monitor patient responses, modify
respiratory therapy based upon patient response, provide information and
education to patients about deficiencies or disorders of the cardiopulmonary
system, and supervise others in the delivery of appropriate respiratory
therapy procedures.

(7) RESPIRATORY THERAPY OR CARE. Therapy, management, rehabilitation,
diagnostic evaluation, and care of patients with deficiencies and
abnormalities of the cardiopulmonary system and associates aspects of other
systems functions, given by a health care professional under the direction
of a physician. The term includes, but is not limited to, the following
activities conducted upon written prescription, verbal order, or medically
approved protocol:

(a) Direct and indirect pulmonary care services that are safe, aseptic,
preventive, or restorative to the patient.

(c) Observation and monitoring of signs and symptoms, general behavior, and
general physical response to respiratory therapy treatment and diagnotist
testing and determination of whether such signs, symptoms, reactions,
behavior, or general responses exhibit abnormal characteristics and
implementation, based on observed abnormalities, of appropriate reporting or
referral practices or prescribed and medically approved respiratory therapy
protocols or appropriate changes in a treatment regimen, pursuant to a
prescription by a physician, or the initiation of emergency procedures.

(d) The diagnostic and therapeutic use of any of the following, in
accordance with the prescription of a physician:

(e) The transcription and implementation of the written and verbal orders of
a physician pertaining to the practice of respiratory therapy.

(f) Institution of known and medically approved protocols relating to
respiratory therapy in emergency situations in the absence of immediate
direction by a physician and institution of specific procedures and
diagnostic testing related to respiratory therapy as ordered by a physician
to assist in diagnosis, monitoring, treatment, and medical research.

(g) Delivery of respiratory therapy procedures, instruction, and education
of patients in the proper methods of self-care and prevention of
cardiopulmonary diseases and other conditions requiring the use of
respiratory therapy equipment or techniques.

(a) Except as provided in Section 34-27B-7, no person shall hold himself or
herself out to be, or function as, a respiratory therapist in this state
unless licensed in accordance with this chapter.

(b) In order to obtain a respiratory therapist license, an applicant shall
demonstrate to the board the he or she is a citizen of the United States or,
if not a citizen of the United States, a person who is legally present in
the United States with appropriated documentation from the federal
government, at least 18 years of age, is a high school graduate, or has the
equivalent of a high school diploma, and meets one of the following
requirements:

(1) Holds credentials as a registered respiratory therapist (RRT) or a
certified respiratory therapist (CRT), as granted by the National Board for
Respiratory Care or its successor organization.

(2) Holds a temporary license issued under subsection (d) of Section
34-27B-7 and passed the examination leading to the CRT or RRT credential.

(3) Has a valid respiratory therapist license from another state, the
District of Columbia, or a territory of the United States, whose
requirements for licensure are considered by the board as substantially
similar to those of Alabama and who otherwise meets the reciprocity
requirements established by the board.

(4) Meets the requirements of subdivision (2) of subsection (d) of Section
34-27B-7.

(5) Has been approved by the board as otherwise qualified by special
training and has passed the licensure examination established by the board
in subsection (c ).

(c) The board shall arrange for the administration of a licensure
examination administered by the state or a national agency approved by the
board. The examination shall be validated and nationally recognized as
testing respiratory care competencies. The board may enter into agreements
or contracts, consistent with state law, with outside organizations for the
purpose of developing, administering, grading, and reporting the results of
licensure examinations. Such organizations shall be capable of meeting the
standards of the National Commission for Health Certifying Agencies, or its
equivalent or successor organization. The board shall establish criteria for
satisfactory performance on the examination.

(4) Promulgate and publish rules in accordance with the Administrative
Procedure Act to administer this chapter.

(5) Conduct hearings on charges calling for the denial, suspension,
revocation, or refusal to renew a license.

(6) Maintain an up-to-date list of every person licensed to practice
respiratory therapy pursuant to this chapter. The list shall include the
last known place of residence and the state license number of the licensee.

(7) Maintain an up-to-date list of persons whose licenses have been
suspended, revoked, or denied. The list shall include the name, Social
Security number, type, date, and cause of action, penalty incurred, and the
length of the penalty. The information on the list, except for Social
Security numbers, shall be available for public inspection during reasonable
business hours and the information may be shared with others as deemed
necessary and acceptable by the board.

(a) The Alabama State Board of Respiratory Therapy is created to implement
and administer this chapter and shall be composed of five members appointed
by the Governor. Three of the members shall be respiratory therapists, one
member shall be the chief executive officer of a hospital, and one member
shall be a physician. The respiratory therapist members of the board
appointed by the Governor shall be selected from a list of names submitted
by the Alabama Society for Respiratory Care. The list shall include two
names for each appointed position to be filled. The respiratory therapist
members appointed to the board shall be registered or certified by the
National Board for Respiratory Care or its successor organization.
Respiratory therapists selected for subsequent appointments must be licensed
by the state. The hospital member shall be selected from a list of names
submitted by the Alabama Hospital Association. The physician member
appointed shall be duly licensed to practice medicine in Alabama and shall
be a member of at least one of the following: The American Thoracic Society,
the American College of Chest Physicians, the American Society of
Anesthesiologists, or the American Academy of Pediatrics. The physician
member of the board appointed by the Governor shall be selected from a list
of names submitted by the Medical Association of the State of Alabama. Such
lists shall include two names for the position.

(b) All board members shall be residents of Alabama and the composition of
the board shall reflect the racial, gender, geographic, urban/rural, and
economic diversity of the state.

(c) The Governor shall make the appointments for all positions for members
of the board within 90 days of the date the position becomes available,
including initial appointments, vacancies, and replacements at the end of
the term of service.

(d) Members of the board shall have the same immunities from personal
liability as state employees for actions taken in the performance of their
official duties.

(e) The term of office of those members first appointed shall be as follows:
Two respiratory therapists and the hospital member, as determined by the
Governor, shall serve for terms of two years, and one respiratory therapist
and the physician member shall serve for terms of four years. Thereafter,
the term of all members shall be for four years. No member shall be
appointed for more than three consecutive full terms. A vacancy in an
unexpired term shall be filled in the manner of the original appointment.
The board shall elect a chair and vice chair annually.

(f) The board shall meet at least twice a year at a time and place
determined by the chair. A majority of the members of the board shall
constitute a quorum for the transaction of business.

(g) Each member shall serve without compensation, but shall be reimbursed
for travel expenses incurred in attendance at meetings of the board and any
other expenses incurred on business of the board at its discretion. Board
members shall also receive a per diem allowance following the guidelines for
state employees. The reimbursement for expenses and per diem shall be paid
from funds derived from the Alabama State Board of Respiratory Therapy Fund.

There is hereby established a separate special trust fund in the State
Treasury to be known as the Alabama State Board of Respiratory Therapy Fund.
All funds received by the board shall be deposited into the fund and shall
be expended only to implement and administer this act. No monies shall be
withdrawn or expended only to implement and administer this act. No monies
shall be withdrawn or expended from the fund for any purpose unless the
monies have been appropriated by the Legislature and allocated pursuant to
this act. Any monies appropriated shall be budgeted and allocated pursuant
to the Budget Management Act in accordance with Article 4, (commencing with
Section 41-4-80) of Chapter 4 of Title 41, and only in the amounts provided
by the Legislature in the general appropriations act or other appropriations
act. Funds shall be disbursed only upon a warrant of the State Comptroller
upon itemized vouchers approved by the chair. After the first three full
fiscal years from May 17, 2004, and every three years thereafter, if a
surplus of funds exists which is greater than two years' operating expense,
the funds shall be distributed to the General Fund.

(a) The board shall issue a respiratory therapist license to any person who
meets the qualifications required by this chapter and who pays the license
fee established herein.

(b) Any person who is issued a license as a respiratory therapist under this
chapter may use the words "licensed respiratory therapist" or the letters
"LRT" in connection with his or her name to denote his or her license.

(c) A license issued under this chapter shall be subject to biennial
renewal.

(d) (1) The board may issue a six-month temporary license as a respiratory
therapist to persons who have graduated from a respiratory therapy
educational program accredited by the Council on Allied Health Education
Programs (CAHEP) in collaboration with the Committee on Accreditation for
Respiratory Care (CoARC), or their successor organizations, and who have
applied for and are awaiting competency examination. The temporary license
shall be renewable only once for an additional six-month period if the
applicant fails the examination. Exceptions may be made at the discretion of
the board based upon an appeal identifying extenuating circumstances. The
holder of a temporary license may only provide respiratory therapy or care
activities, services, and procedures as defined in Section 34-27B-2 under
the direct clinical supervision of a licensed respiratory therapist or
physician.

(2) The board shall grant a license as a respiratory therapist to other
persons who do not meet the qualifications for licensure pursuant to Section
34-27B-3, but who, on the effective date of the adoption of the rules and
regulations of the board, are currently employed in the administration of
respiratory therapy under the direction of a physician in the State of
Alabama. The opportunity to apply for a respiratory therapy license issued
under this subdivision shall expire 365 days after implementation of the
rules of the board. Holders of these licenses shall be eligible to renew
their licenses as are any other licensed respiratory therapists under this
chapter.

(a) The board may refuse to renew a license, may suspend or revoke a
license, may impose probationary conditions, or may impose an administrative
fine not to exceed five hundred dollars ($500) per violation, as
disciplinary actions if a licensee or applicant for licensure has been found
guilty of unprofessional conduct that has endangered, or is likely to
endanger, the health, welfare, or safety of the public. Unprofessional
conduct includes, but is not limited to, the following:

(1) Obtaining a license by means of fraud, misrepresentation, or concealment
of material facts.

(2) Being found guilty of unprofessional conduct as defined by the rules
established by the board, or violating the code of ethics adopted and
published by the American Association for Respiratory Care of its successor
organization.

(3) Conviction of a crime, other than a minor offense, in any court if the
offense has a direct bearing on whether the person should be entrusted to
serve the public in the capacity of a respiratory therapist.

(b) The board, after a hearing, may exercise the disciplinary actions
authorized in subsection (a). The board shall adopt policies for the conduct
of the hearings. One year after the date of the revocation of a license,
application may be made to the board for reinstatement. The board shall hold
a hearing to consider any application for reinstatement.

(c) The board may establish rules regarding the disciplinary actions
authorized in subsection (a) in accordance with the Administrative Procedure
Act.

(d) A suspended license is subject to expiration during the suspension
period.

(a) A person who does not hold a license or a temporary license as a
respiratory therapist or whose license or temporary license has been
suspended or revoked may not do any of the following:

(1) Use in connection with the person's practice the words "respiratory care
professional," "respiratory therapist," "respiratory care practitioner,"
"certified respiratory care practitioner," "licensed respiratory therapist,"
"inhalation therapist," or "respiratory therapy technician"; or use the
letters "R.C.P." or "L.R.T."; or use any other words, letters,
abbreviations, or insignia indicating or implying that the person is a
respiratory therapist.

(2) Directly or by implication represent in any way that the person is a
respiratory therapist.

(b) A person who holds a license or a temporary license to practice
respiratory therapy under this chapter may use the title "respiratory
therapist" and the abbreviation "L.R.T."

Nothing in this chapter shall be construed as preventing or restricting the
practice, services, or activities of any of the following:

(1) Any person who is licensed in Alabama or certified by an organization
accredited by the National Commission for Certifying Agencies and acceptable
to the state from engaging in the profession or occupation for which the
person is licensed or certified.

(2) Any person employed by the United States government who provides
respiratory therapy solely under the direction or control of the United
States government agency or organization.

(3) Any person receiving clinical training while pursuing a course of study
leading to registry or certification in a respiratory therapy educational
program accredited by the Council on Allied Health Education Programs in
collaboration with the Committee on Accreditation for Respiratory Care or
their successor organizations. This person will be under direct supervision
and be designated by a title clearly indicating his or her status as a
student or trainee.

(4) Any emergency medical technician licensed by the Alabama State Board of
Health who is providing care to a patient at the scene of an emergency, or
during transport of the patient in a licensed ground ambulance, provided
that such care may not exceed the scope of care permissible under the rules
of the Alabama State Board of Health.

(5) The delivery of respiratory therapy of sick or disabled persons by
family members or domestic servants or the care of non-institutionalized
persons by a surrogate family member as long as the persons do not represent
themselves as, or hold themselves out to be, respiratory therapists.

(6) Any individual who has demonstrated competency in one or more areas
covered by this chapter as long as the individual performs only those
functions that he or she is qualified by examination to perform. The
standards of the National Commission for Certifying Agencies, or its
equivalent, shall serve as a standards with which to evaluate those
examinations and examining organizations.

(7) Any person performing respiratory services or care not licensed as a
respiratory therapist in accordance with this chapter who is employed in a
diagnostic laboratory, physician's office, clinic, or outpatient treatment
facility and whose function is to administer treatment or perform diagnostic
procedures confined to that laboratory, office, clinic, or outpatient
facility under the direction of a licensed physician.

(8) Any respiratory therapy student who performs limited respiratory therapy
procedures as an employee of any health care provider organization while
enrolled in a respiratory therapy educational program accredited by the
Council on Allied Health Education Programs in collaboration with the
Committee on Accreditation for Respiratory Care or their successor
organizations. The employee shall be designated by title as a student or
trainee and shall work under direct supervision.

(9) Any individual employed by a durable medical equipment or home medical
equipment company who delivers, sets up, or maintains respiratory equipment,
but not including assessment or evaluation of the patient.

(10) Any individual employed as a polysommagraphic technologist working in a
sleep center or diagnostic sleep clinic.

(11) Any licensed respiratory therapist performing advances in the art and
techniques of respiratory therapy learned through special training
acceptable to the board.

(a) The board shall provide notification to all respiratory therapists
employed as such or practicing respiratory therapy in Alabama on May 17,
2004. The notification shall summarize the requirements of this chapter and
provide information on procedures for obtaining a license. Publication of
the notification shall be accompanied by complying with all of the following
requirements:

(1) A letter containing the notice shall be directed to all persons
registered or certified by the National Board for Respiratory Care who
reside in the State of Alabama, based on the most current mailing list of
the National Board for Respiratory Care.

(2) Notice shall be published in all major state trade or professional
journals relating to respiratory therapy for not less than three consecutive
months.

(3) Notice shall be published in all daily newspapers in this state at least
once per month for three consecutive months.

(b) The board shall cause the notices required by this section to commence
within 30 days from the effective date of adoption of rules and regulations
by the board.

The board shall be subject to the Alabama Sunset Law, as provided in Chapter
20, Title 41, as an enumerated agency as provided in Section 41-20-3, and
shall have a termination date of October 1, 2008, and every four years
thereafter, unless continued pursuant to the Alabama Sunset Law.